Alcohol and Risk of Breast Cancer in Postmenopausal Women: An Analysis of Etiological Heterogeneity by Multiple Tumor Characteristics
Alcohol and Risk of Breast Cancer in Postmenopausal Women: An Analysis of Etiological Heterogeneity by Multiple Tumor Characteristics
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DOI：
10.1093/aje/kwu189
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发表时间：
2014-10-01
影响因子：
5
通讯作者：
Ziegler, Regina G.
中科院分区：
文献类型：
--
作者：
Falk, Roni T.;Maas, Paige;Ziegler, Regina G.
饮酒是乳腺癌的一个确定的危险因素。这种关联是否因特定的肿瘤特征而变化而独立于其他特征尚不清楚。我们评估了前列腺癌、肺癌、结直肠癌和卵巢癌筛查试验队列中饮酒与乳腺癌风险之间的关系（1993年至2001年在10个美国筛查中心招募了54,562名年龄在55-74岁之间的女性，中位随访8.9年，1905例浸润性乳腺癌病例）。用标准Cox模型计算由组织学类型和雌激素受体(ER)/孕激素受体（PR）状态定义的亚型的风险比和95%置信区间。一种新的2期Cox模型评估了个体肿瘤特征风险的异质性，同时对其他特征进行了调整。观察到不同类别酒精消费的显著趋势，每周饮酒7杯或更多的人与从不饮酒者的风险比如下：雌激素受体阳性（ER+）癌症的风险比为1.48(95%置信区间（CI）： 1.19, 1.83)；孕激素受体阳性（PR+）癌，1.64 (95% CI: 1.31, 2.06)；ER+/PR+癌为1.63 (95% CI: 1.30, 2.05)；混合性导管/小叶癌为2.51 （95% CI: 1.20, 5.24）。对于ER+和PR+癌症，导管型和混合导管/小叶型的趋势显著。PR状态与ER状态呈正相关（PR状态调整后，ER状态p异质性= 0.70）。并不是所有的乳腺癌亚型都与饮酒有关。未来的工作应强调大规模的合作研究，精确的亚型定义，以及对相关肿瘤特征的调整。
Alcohol consumption is an established risk factor for breast cancer. Whether associations vary by specific tumor characteristics independent of other characteristics is unclear. We evaluated the association between alcohol consumption and breast cancer risk in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial cohort (54,562 women aged 55-74 years recruited at 10 US screening centers between 1993 and 2001; median follow-up, 8.9 years; 1,905 invasive breast cancer cases). Hazard ratios and 95% confidence intervals for subtypes defined by histological type and estrogen receptor (ER)/progesterone receptor (PR) status were calculated with standard Cox models. A novel 2-stage Cox model assessed heterogeneity in risk for individual tumor characteristics while adjusting for others. Significant trends across categories of alcohol consumption were observed, with hazard ratios for those consuming 7 or more drinks per week versus never drinkers as follows: for estrogen receptor-positive (ER+) cancer, 1.48 (95% confidence interval (CI): 1.19, 1.83); for progesterone receptor-positive (PR+) cancer, 1.64 (95% CI: 1.31, 2.06); for ER+/PR+ cancer, 1.63 (95% CI: 1.30, 2.05); and for mixed ductal/lobular cancer, 2.51 (95% CI: 1.20, 5.24). For ER+ and PR+ cancers, trends were significant for ductal and mixed ductal/lobular types. PR status explained the positive association with ER status (for ER status, P-heterogeneity = 0.70 after adjustment for PR status). Alcohol consumption was not associated with all breast cancer subtypes. Future work should emphasize large collaborative studies, precise definition of subtypes, and adjustment for correlated tumor characteristics.